[Efficacy of percutaneous vagal stimulation in the treatment of chronic tinnitus].

Objective:The aim of this study is to investigate the efficacy of transcutaneous vagus nerve stimulation（taVNS） in the treatment of chronic tinnitus. Methods:taVNS was used to treat chronic decompensated tinnitus, 10 days as a course of treatment. Record and analyze the improvement of the patient's subjective symptoms during treatment. The THI, PSQI and DASS-21 scores were performed at 10 days, 3 months and 6 months after treatment. The improvement of tinnitus in taVNS group and control group at the above recorded time points was compared, and the THI score of taVNS group was compared before and after treatment. Results:① During the taVNS treatment, 93.65% of the patients achieved improvement in subjective symptoms, and 28.6% of the patients voluntarily accepted the second course of taVNS treatment; ② The sleep improvement was optimal when the treatment was 10 days, and some patients had poor sleep status after 3 or 6 months; ③ The anxiety of taVNS group was improved during and after treatment, and the best effect time was 3 months and 6 months after treatment; ④ There was no significant difference in THI score between the two groups, but there was significant improvement in taVNS group at 3 months and 6 months after treatment. Conclusion:taVNS treatment can significantly improve the sleep disorder, anxiety disorder and tinnitus disturbance of tinnitus patients, and the curative effect is good after 3 months and 6 months of prevention.

Social Support and Tinnitus Distress: The Importance of Developing Positive Psychological Qualities in Patients with Chronic Tinnitus.

INTRODUCTION: The role of social support in the relief of tinnitus distress and related mechanisms remains unclear. This study aimed to confirm a hypothesis that the influence of social support on tinnitus distress is mediated by resilience and self-esteem. METHODS: The Social Support Rating Scale, Connor-Davidson Resilience Scale, Positive Version of Rosenberg Self-Esteem Scale, and Tinnitus Handicap Inventory were used to assess 296 patients who experience chronic subjective tinnitus. The collected data were subjected to correlational analysis, mediating effect testing, and structural equation model analysis using R 3.3.1 with the mediate and lavaan packages. RESULTS: The result showed that social support had significant positive correlations with resilience and self-esteem, while resilience and self-esteem had significant negative correlations with tinnitus distress. Furthermore, social support indirectly affected tinnitus distress through the full mediating effects of resilience and self-esteem and could indirectly affect resilience through the partial mediating effects of self-esteem. CONCLUSION: These results suggested that the key to social support for alleviating tinnitus distress lies in the development of patients' resilience and self-esteem. Promoting the development of positive psychological quality of tinnitus patients and improving their perception of social support may become the new approaches of clinical management of tinnitus.

Etiology of newborn hearing impairment in Guangdong province: 10-year experience with screening, diagnosis, and follow-up.

BACKGROUND: Hearing impairment is one of the most common birth defects in children. Universal newborn hearing screenings have been performed for 19 years in Guangdong province, China. A screening/diagnosis/intervention system has gradually been put in place. Over the past 10 years, a relatively complete data management system had been established. In the present study, an etiological analysis of newborn cases that failed the initial and follow-up screenings was performed. METHODS: The nature and degree of hearing impairment in newborns were confirmed by a set of procedures performed at the time of initial hearing screening, rescreening and final hearing diagnosis. Then, multiple examinations were performed to explore the associated etiology. RESULTS: Over a period of 10 years, 720 children were diagnosed with newborn hearing loss. Among these children, 445 (61.81%) children had a clearly identified cause, which included genetic factor(s) (30.56%), secretory otitis media (13.30%), maternal rubella virus infection during pregnancy (5.83%), inner ear malformations (4.86%), maternal human cytomegalovirus infection during pregnancy (2.92%), malformation of the middle ear ossicular chain (2.50%) and auditory neuropathy (1.81%). In addition, 275 cases of sensorineural hearing loss of unknown etiology accounted for 38.19% of the children surveyed. CONCLUSIONS: Long-term follow-up is needed to detect delayed hearing impairment and auditory development in children. The need for long-term follow-up should be taken into account when designing an intervention strategy. Furthermore, the use of the deafness gene chip should further elucidate the etiology of neonatal hearing impairment.

Loss of Vision Dominance at the Preresponse Level in Tinnitus Patients: Preliminary Behavioral Evidence.

At present, the mechanisms underlying changes in visual processing in individuals with tinnitus remain unclear. Therefore, we investigated whether the vision dominance of individuals with tinnitus disappears at the preresponse level through behavioral study. A total of 38 individuals with tinnitus and 31 healthy controls completed a task in which they were asked to attend to either visual or auditory stimuli while ignoring simultaneous stimulus inputs from the other modality. We manipulated three levels of congruency between the simultaneous visual and auditory inputs: congruent (C), incongruent at the preresponse level (PRIC), and incongruent at the response level (RIC). Thus, we differentiated the cross-modal conflict explicitly into the preresponse (PRIC > C) and response (RIC > PRIC) levels. The results revealed no significant difference in the size of the preresponse level conflict between the auditory attention and visual attention conditions in tinnitus group. In brief, the preresponse level of individuals with tinnitus showed a loss in vision dominance. This may be due to the reduced interference of visual information in auditory processing.

Eyes and Ears: Cross-Modal Interference of Tinnitus on Visual Processing.

The visual processing capacity of tinnitus patients is worse than normal controls, indicating cross-modal interference. However, the mechanism underlying the tinnitus-modulated visual processing is largely unclear. In order to explore the influence of tinnitus on visual processing, this study used a signal recognition paradigm to observe whether the tinnitus group would display a significantly longer reaction time in processing the letter symbols (Experiment 1) and emotional faces (Experiment 2) than the control group. Signal detection and signal recognition, which reflect the perceptual and conceptual aspects of visual processing respectively, were manipulated individually in different conditions to identify the pattern of the cross-modal interference of tinnitus. The results showed that the tinnitus group required a significantly prolonged reaction time in detecting and recognizing the letter symbols and emotional faces than the control group; meanwhile, no between-group difference was detected in signal encoding. In addition, any gender- and distress-modulated effects of processing were not found, suggesting the universality of the present findings. Finally, follow-up studies would be needed to explore the neural mechanism behind the decline in speed of visual processing. The positive emotional bias in tinnitus patients also needs to be further verified and discussed. Highlights: - The bottom-up visual processing speed is decreased in tinnitus patients. - Tinnitus primarily interferes with the detection of the visual signals in individuals.

Attentional Bias in Patients with Decompensated Tinnitus: Prima Facie Evidence from Event-Related Potentials.

Tinnitus refers to the auditory perception of sound in the absence of external sound or electric stimuli. The influence of tinnitus on cognitive processing is at the cutting edge of ongoing tinnitus research. In this study, we adopted an objective indicator of attentional processing, i.e. the mismatch negativity (MMN), to assess the attentional bias in patients with decompensated tinnitus. Three kinds of pure tones, D1 (8,000 Hz), S (8,500 Hz) and D2 (9,000 Hz), were used to induce event-related potentials (ERPs) in the normal ear. Employing the oddball paradigm, the task was divided into two blocks in which D1 and D2 were set as deviation stimuli, respectively. Only D2 induced a significant MMN in the tinnitus group, while neither D1 nor D2 was able to induce MMN in the control group. In addition, the ERPs in the left hemisphere, which were recorded within the time window of 90-150 ms (ERP 90-150 ms), were significantly higher than those in the right hemisphere in the tinnitus group, while no significant difference was observed in the control group. Lastly, the amplitude of ERP 90-150 ms in the tinnitus group was significantly higher than that in the control group. These findings suggest that patients with decompensated tinnitus showed automatic processing of acoustic stimuli, thereby indicating that these patients allocated more cognitive resources to acoustic stimulus processing. We suggest that the difficulty in disengaging or facilitated attention of patients might underlie this phenomenon. The limitations of the current study are discussed.

[Social psychological factors causes of acute exacerbation or re-decompensation of clinically significant chronic tinnitus].

OBJECTIVE: To analyze social-psychological causes of acute exacerbation or re-decompensation of chronic tinnitus and provide theoretical basis for controlling and preventing tinnitus exacerbation and re-decompensation. METHOD: Systemic audiological tests and tinnitus handicap inventory were performed on 136 chronic tinnitus patients with acuteexacerbation or re-decompensation. For the patients with new hearing loss, a further investigation of living conditions and assessment of social support rating scale were utilized. The patients with relatively definite causes were treated accordingly. RESULT: (1) There were 89 patients complained of new changes of hearing, all of whom could tell the definite time point of tinnitus exacerbation, and 5 of them felt the exacerbation of hearing loss meanwhile. (2) Forty-two patients encountered adverse events on life or working, and tinnitus exacerbation occurred within several weeks to 3 months afterwards. Most of these patients could not tell the definite time point of tinnitus exacerbation or re-decompensation. Five cases of tinnitus exacerbation didn't tell any adverse events on life or working, but showed mood disorders, and the anti-anxiety treatment was effective to them. (3) Forty-seven cases without new hearing loss scored significantly lower in SSRS than healthy adults. CONCLUSION: Emerging hearing loss is the main cause of acute exacerbation of chronic tinnitus. To find it in time and give effective treatment can save newly presented hearing loss, cure or relieve tinnitus. Adverse events in life(or working) and short of social support is another important cause of acute exacerbation of chronic tinnitus or decompensation recurrence, which suggests that social-psychological factors besides of hearing loss should be concerned in diagnosis and treatment of tinnitus.

[Vertigo due to enlarged vestibule with lateral semicircular canal dysplasia: an analysis of clinical characteristics].

OBJECTIVE: To explore the clinical characteristics and possible pathological mechanisms of vertigo due to enlarged vestibule with lateral semicircular canal dysplasia. METHODS: A retrospective review was conducted for 5 cases of peripheral vertigo due to enlarged vestibule with lateral semicircular canal dysplasia. Their characteristics of medical history, precipitating factors, course of vertigo, auditory tests, vestibular tests and imaging examine results were analyzed. RESULTS: The clinical characteristics were as follows. (1) Specifics of medical history: 4 cases suffered delays in gross motor development and potential equilibrium dysfunctions. One case failed to recount an earlier medical history, but could maintain normal hearing and vestibular functions for a long time in adulthood. (2) Most cases could identify the precipitating factors of initial attacks, such as head-bumping, nose-blowing and constipation, etc. resulting in sudden rises of intracranial or abdominal pressures. (3) Paroxysmal vertigo and progressive hearing loss were mimicking Meniere disease or large vestibular aqueduct syndrome. But its course of vertigo was different from those of Meniere disease and large vestibular aqueduct syndrome with regards to hearing levels and audiograms. (4) Some cases had positional vertigo. But the results of Dix-Hallpike and Roll tests were different from benign paroxysmal positioning vertigo (BPPV). (5) The inner ear imaging showed enlarged vestibule with lateral semicircular canal dysplasia. CONCLUSION: The enlarged vestibule with lateral semicircular canal dysplasia is a rare etiology of peripheral vertigo. The history of delays in gross motor development and potential equilibrium dysfunctions in childhood may offer important diagnostic clues. And audiological and vestibular tests, high-resolution computed tomography and magnetic resonance may help to ascertain the diagnosis.

[Analysis of factors affecting the pure tone threshold glycerol test].

OBJECTIVE: To probe the factors that affect the pure-tone threshold glycerol test and the distribution of frequencies in positive glycerol test. METHOD: We tested the pure-tone threshold before and after glycerol intake in patients with Meniere's disease, and then analyzed the positive rates,distribution of positive frequencies and the time when the maximum threshold changes appeared. RESULT: The positive rate of pure-tone glycerol test was 72.09%, of which the threshold descending rate was 47.67%, and the threshold rebounding rate was 24.42%; the pure-tone threshold changes of descending group and rebounding group were (17.41 +/- 9.92) dB, (13.53 +/- 4.64) dB respectively, and the differences were significant. The distribution of positive frequencies were 250 Hz, 125 Hz, 500 Hz, 1 kHz, 4 kHz, 2 kHz, 8 kHz in descending order. The maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake. CONCLUSIONS: Patient selection, test occasion and the judgement criteria may affect the positive rate of glycerol test; the positive frequencies distribute in the low-frequency region mainly; the maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.

[Acute aggravation of chronic tinnitus: a study of the hearing characteristic and prognosis].

OBJECTIVE: To investigate the hearing change when chronic tinnitus acute aggravated and the affect of prognosis due to hearing change. METHODS: The pure tone threshold and acoustic immittance were used for every case in the acute aggravation of chronic tinnitus (AACT) group, and for some of AACT group members the auditory brainstem response (ABR), distort-product otoacoustic emission (DPOAE), electrocochleogram (EcochG), glycerin test and MRI were used at the same time for further diagnosis. For the chronic tinnitus, the patients accepted the intervention of tinnitus retraining therapy (TRT) both for the AACT group and the control group. As for the recent hearing loss appeared in the AACT group members, the patients were treated the cases as the sudden deafness, and then the hearing characteristic of the AACT group was analyzed and the effect of the chronic tinnitus both for the AACT group and control group after the TRT for 3, 6, 9 and 12 months was evaluated. RESULTS: Three kinds of hearing changes appeared when chronic tinnitus acute aggravated. Based on the dated high frequencies hearing loss ranged 4-8 kHz, recent hearing loss appeared in 1-2 middle frequencies near the impaired high frequencies; Based on the dated single middle frequency hearing loss, another middle frequency hearing impaired near the dated hearing loss frequency, the sawtooth-like audiogram changed to groove-like audiogram; Hearing fluctuation in low frequency area, hearing threshold increased 10-30 dB in 125-1000 Hz but kept unchanged in the high frequency area. The recent local frequency hearing loss healed after the vasodilator and neurotrophic drugs therapy, but the dated hearing loss can't rehabilitate. Along with the rehabilitation of recent local hearing loss, 25 of 32 cases chronic tinnitus victims get to habituation; this finding showed that the experience of tinnitus aggravation and relief accelerated the habituation. Until the 12 months after the TRT, the curative effect difference between AACT group and control group showed statistical significance. CONCLUSIONS: When the chronic tinnitus acute aggravated, 3 kinds of local area hearing impaired. Timely diagnosis and effective treatment had brought not only hearing rehabilitation but also promotion to habituation of chronic tinnitus.